EP507 - Timing of Urgent Colectomy for Cancer: A NSQIP Analysis

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Purpose/Background: The timing of urgent surgery variably affects surgical outcomes: in common emergency general surgery (EGS) procedures, delayed operations correlate with increased mortality and morbidity. However, for certain indications in colon surgery, e.g., diverticulitis and appendicitis, observation may be safe. We sought to examine patterns in time to surgery for urgent colectomy in cancer cases, where malignancy may influence risk profiles. The aim of this study is to evaluate whether surgical delays for colorectal cancer patients presenting for emergency colectomies are associated with variations in 30-day mortality and postoperative morbidity. We hypothesize that later time-to-surgery will not significantly increase risk, as cancer cases may warrant delay for staging or recent chemotherapy use.

Methods/Interventions: This retrospective cohort study utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Procedure Targeted Colectomy data from 2015 to 2021. Patients aged ≥18 who underwent non-elective colectomy for pathology-confirmed colon cancer were included. Time to surgery was categorized as early (≤48 hours) or late (>48 hours). The primary outcome was 30-day postoperative mortality, while secondary outcomes included any complications and serious complications. A multivariable logistic regression model was employed to adjust for confounders such as age, race/ethnicity, comorbidities, frailty, disseminated cancer, and other clinical factors.

Results/Outcomes: 8049 patients (mean age 68.3 years, 49.3% male, 50.7% White) underwent urgent colectomy. The mean time to the operating room (OR) for the entire cohort was 1.5 days ± 2.05 (mean ± std dev) with 67.2% categorized as early operation. The most common indications for surgery included obstruction (57.6%), perforation (26.9%), and bleeding (6.4%). The mean time to OR was significantly greater for bleeding (3.5 days ± 2.53,) compared to obstruction (1.57 ± 1.95) and perforation (1.00 ± 1.79). Compared to early operation, patients with late operation were older (67.7 years +/- 14.7 vs 69.7 +/- 15.1 p<.0001), with 2 or more comorbidities (22.6% vs 17.5%, p<.001), but fewer had preoperative sepsis (22.6% vs 41.9%, p<.001) or disseminated cancer (22.0% vs 25.6%, p=.0005). Late operations had increased risk for any complications (53.6% vs 48.7%; P< 0.001) and serious complications (58.6% vs 53.4%; p< 0.001). There were no differences in unadjusted 30-day mortality (91.1% vs. 90.2%; p=0.19). After adjusting for age, race, ethnicity, comorbidities, sepsis, disseminated cancer, and transfer status, late operation did not increase risk for 30-day mortality (odds ratio [OR], 1.158; 95% CI, 0.970-1.380), any complications (OR, 1.014; 95% CI, 0.916-1.123), or serious complications (OR, 1.042, 95% CI, 0.939-1.156).

Conclusion/Discussion: Time to urgent colectomy in colorectal cancer patients was not significantly associated with 30-day mortality or complications after adjusting for clinical factors. This should provide reassurance and support surgeons in using their clinical judgment to individualize time to OR for colectomy in cancer patients.